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Background: Anti-tumor necrosis factor-α (TNF-α) is a life-changing treatment leading to quality-of-life improvement. Nonetheless, this treatment is associated with a high risk of infection, especially tuberculosis. Objective: Our study aimed to determine the frequency of active tuberculosis in our patients with chronic rheumatic disease and treated with TNF-α. Methods: We conducted a retrospective study including patients with Rheumatoid Arthritis and Spondylarthritis diagnosed according to ACR/EULAR 2009 criteria and ASAS 2010, respectively, and treated with biological agents for at least 6 months. We collected data regarding tuberculosis screening and the occurrence of active tuberculosis during follow-up. Results: 82 patients were included (37 men and 45 women). The mean age was 42 ± 3.4 years. At inclusion, no patient had a medical history of tuberculosis. The diagnosis of latent tuberculosis infection was established in 17 patients (20.7%). Prophylactic treatment was prescribed in all these cases for three months. Two cases (2.4%) of active tuberculosis occurred under biologic (infliximab). It was two severe forms of tuberculosis. The first case had miliary tuberculosis associated with hepatic and peritoneal involvement. The second one had pleural tuberculosis. These two patients received anti-tuberculosis therapy, and the biological treatment was interrupted. Given the high disease activity, the anti-TNF-α was restarted after 3 and 4 months. There was no recurrence of tuberculosis after 7 years of follow-up. Conclusion: The use of TNF-α blockers is associated with a risk of disseminated forms of tuberculosis. Tuberculosis screening, which is recommended before the biological onset, is also necessary under this treatment. Restarting the anti-TNF-α after appropriate treatment of tuberculosis seemed to be safe.

Increased Risks of Infections in Diabetes According to Carey et al. ( Diabetes Care , doi.org/cjxp), individuals with diabetes, and especially those with type 1 diabetes, likely carry a substantially increased risk for infections in comparison to the general public. The authors say that the risk of infection attributable to diabetes likely represents a considerable burden for both patients and health care systems. They call for research to explore education and management strategies to reduce poor outcomes and point out that diabetes-related infection rates are only likely to go up as diabetes rates increase and the population ages. Notable for its large size, the study tracked infection rates and infection-related hospitalizations and mortality in just over 100,000 individuals with diabetes and just over 200,000 matched control individuals without diabetes in England between 2008 and 2015. The researchers then compared rates between individuals with and without diabetes and also between individuals with type 1 versus type 2 diabetes versus control individuals. Notably, they also adjusted the findings for a range of confounding factors such as smoking, BMI, and age—something that previous studies have not consistently accounted for. Compared to those without diabetes, patients with diabetes had higher rates of infections and hospitalization due to infection. Rate disparities were consistently greater in those with type 1 diabetes than in those with type 2 diabetes compared to control subjects. Bone and joint infections, sepsis, and cellulitis showed the largest disparities between individuals with type 2 diabetes and control subjects, whereas, for those with type 1 diabetes, bone and joint infections, sepsis, and endocarditis showed the greatest disparities versus control subjects. Adjusting for factors such as smoking, age, sex, BMI, and deprivation reportedly did not substantially change the outcomes. “People with diabetes, particularly type 1 diabetes, are at increased risk of serious infection, representing an important population burden,” the authors concluded. …

The coronavirus disease 2019 (COVID-19) pandemic has generated high interest in factors modulating risk of infection, disease severity and recovery. Vitamin D has garnered interest since it is known to modulate immune function and vitamin D deficiency is associated with increased risk of respiratory infections and adverse health outcomes in severely ill patients. There are no population representative data on the direct relationship between vitamin D status and severe acute respiratory syndrome coronavirus 2 infection risk and severity of COVID-19. Data from intervention studies are limited to four studies. Here we summarise findings regarding vitamin D status and metabolism and their alterations during severe illness, relevant to COVID-19 patients. Further, we summarise vitamin D intervention studies with respiratory disease outcomes and in critically ill patients and provide an overview of relevant patient and population guidelines. Vitamin D deficiency is highly prevalent in hospitalised patients, particularly when critically ill, including those with COVID-19. Acute and critical illness leads to pronounced changes in vitamin D metabolism and status, suggestive of increased requirements. This needs to be considered in the interpretation of potential links between vitamin D status and disease risk and severity and for patient management. There is some evidence that vitamin D supplementation decreases the risk of respiratory tract infections, while supplementation of intensive care unit patients has shown little effect on disease severity or length of treatment. Considering the high prevalence of deficiency and low risks associated with supplementation, pro-actively applying current population and patient management guidelines to prevent, monitor and correct vitamin D deficiency is appropriate.

There has been growing interest in telemedicine for cystic fibrosis over recent years based largely on convenience for patients and/or increasing the frequency of surveillance and early detection which, it is assumed, could improve treatment outcomes. During 2020, the covid-19 pandemic catalysed the pace of development of this field, as CF patients were presumed to be at high risk of infection. Most clinics adapted to digital platforms with provision of lung function monitoring and sample collection systems. Here, we present the views of multidisciplinary team members at a large paediatric CF centre on what has worked well and what requires further optimisation in the future. In response to the question posed, 'Do we still need face to face clinics?' our answer is 'Yes, but not every time, and not for everyone'.

Background Smell and taste loss are highly prevalent symptoms in coronavirus disease 2019 (COVID-19), although few studies have employed objective measures to quantify these symptoms, especially dysgeusia. Reports of unrecognized anosmia in COVID-19 patients suggests that self-reported measures are insufficient for capturing patients with chemosensory dysfunction. Objectives The purpose of this study was to quantify the impact of recent COVID-19 infection on chemosensory function and demonstrate the use of at-home objective smell and taste testing in an at-risk population of healthcare workers. Methods Two hundred and fifty healthcare workers were screened for possible loss of smell and taste using online surveys. Self-administered smell and taste tests were mailed to respondents meeting criteria for elevated risk of infection, and one-month follow-up surveys were completed. Results Among subjects with prior SARS-CoV-2 infection, 73% reported symptoms of olfactory and/or gustatory dysfunction. Self-reported smell and taste loss were both strong predictors of COVID-19 positivity. Subjects with evidence of recent SARS-CoV-2 infection (

OBJECTIVE To assess the risk factors associated with deep infection after operative treatment of peritalar fracture dislocations. DESIGN A retrospective study was performed to identify patients who had operative treatment of a peritalar fracture dislocation over an 11-year period (2008-2019). SETTING Level 1 trauma center. PARTICIPANTS Patients were identified by review of all surgical billing that included open reduction of peritalar dislocation. Minimum follow-up for inclusion was 3 months or the outcome of interest. A total of 178 patients were identified and 154 patients met inclusion criteria. MAIN OUTCOME The primary outcome was deep infection, defined as return to the operating room for debridement with positive cultures. RESULTS A total of 19 (12.3%) patients developed a post-operative deep infection. The most common associated fractures were talus (47%), calcaneus (33%), and fibula (9%). The infected group was significantly older (47.2 vs 39.5 years, p=0.03). Patients undergoing operative management for peritalar fracture dislocations with current smoking were found to have significantly higher odds of postoperative deep infection (74 vs 34%, aOR=7.4, 95% CI, 2.3-24.1, p=0.001). There was a significantly higher risk of infection in patients with a Gustilo-Anderson type 3 open fractures (32 vs 12%, aOR=5.7, 95% CI, 1.6-20.3, p=0.007). The infected group had high rates of below knee amputation when compared to the group without infection (47 vs 1%, p< 0.001). CONCLUSION In our retrospective study, risk factors for infection after peritalar fracture dislocation included older age, smoking, and Gustilo-Anderson type 3 open fracture. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patients receiving chimeric antigen receptor T cells (CAR-T cells) therapy may be particularly susceptible to coronavirus disease 2019 (COVID-19) because of several factors including the immunosuppression associated to the underlying disease and delayed cytopenias. Regrettably, data on outcomes of CAR-T recipients with COVID-19 are extremely scarce. The aim of this study was to investigate the characteristics and outcomes of COVID-19 in patients treated with CAR-T therapy. The European Hematology Association - Scientific Working Group Infection in Hematology endorsed a survey to collect and analyze data from patients developing COVID-19 after CAR-T therapy. Overall, 459 patients treated with CAR-T cells were reported from 18 European centers. The prevalence of COVID-19 cases was 4.8%. Median time from CAR-T therapy and COVID-19 diagnosis was 169 days. Severe infection occurred in 66.7% of patients and 43.3% of the subjects required admission to ICU. The COVID-19 mortality was 33%. In multivariable analysis, the disease status at the time of COVID-19 trended marginally towards adverse outcome (P=0.075). In conclusion, we documented a high fatality rate for CAR-T patients with COVID-19, supporting the need to design successful interventions to mitigate the risk of infection in this vulnerable group of patients.

OBJECTIVES: Immediately before the state of emergency was declared, there was an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among special training participants with severe physical stress. For promoting the optimization of infection prevention measures by identifying acts and situations with high risk of infection, we conducted a survey and analysis to understand the detailed process of infection spread in these cases. METHODS: A structured interview was conducted for the special training participants on their health status, changes in symptoms, training methods, and behavior history in their private lives. Additionally, a patrol of the training facility was carried out to understand the training environment, and antibody tests were conducted on the close contacts for more accurately grasping the spread of infection, by identifying subclinical infected persons. RESULTS: Within 10 days of COVID-19 onset in the first patient, 15 of the 19 original training participants developed symptoms, and 14 patients tested positive for RT-PCR. PCR tests were also performed on four patients who did not develop the disease - two were positive and negative, each. The two negatives turned positive on a later antibody test, suggesting that there was an asymptomatic infection. In addition, all five patients who participated in the training for only a day developed symptoms and tested positive for PCR in a few days. Of the 64 people who underwent testing for antibodies as close contacts, all but one who was living together with a patient were negative on antibody testing. CONCLUSIONS: The onset of COVID-19 occurred after the start of practice-based training continuously; therefore, the practice-based training was thought to be the main cause of the transmission. We speculate that the main factors behind the rapid spread of infection are as follows: during practice-based training, increased ventilation made it difficult to wear a mask; repeated loud vocalizations at close range; and the training pair was not fixed. Physical training without shouting and desk work, however, did not possess the risk of COVID-19, and avoiding certain situations at high risk of respiratory infections may have significantly reduced SARS-CoV-2 transmission. If personnel become infected with SARS-CoV-2, emergency measures should be devised by identifying patients and close contacts and facilitating the investigation of their behavioral history. Furthermore, evaluating and improving the effectiveness of infection control measures is necessary by ascertaining potentially infected persons by performing PCR tests, antigen tests, antibody tests, etc. in combination.

Introduction The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice. Methods and Results A paper questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients’ family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua – 100; Pakistan – 493; Ecuador – 252; Lebanon – 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared to a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, P

The biggest challenge for the World Health Organization today is the fight against the COVID-19 pandemic. The current situation prompted major adjustments in the system of cancer care. In this review, we investigate the aspects of cancer treatment and care during the pandemic, since in this setting oncological services face challenges in determining the feasibility of anticancer treatments while minimizing the risk of infection. Cancer patients are at a higher risk from COVID-19 disease. Therefore, oncological community is discussing on the priorities for providing cancer therapies and care and at the same time minimizing the risk of infection. © 2022, Institute of Oncology Sremska Kamenica. All rights reserved.

Introduction and objectives: Severe asthma management during the coronavirus disease 2019 (COVID-19) pandemic is a challenge and will continue to be, at least in the next few months, as herd immunity is still a mirage. A lot has to be learned about how COVID-19 affects underlying diseases, and severe asthma is no exception. Methods: Narrative review of papers available until February 2021 in PubMed and Google Scholar, relating severe asthma and COVID-19. Four main research topics were reviewed: SARS-CoV-2 infection: immunology and respiratory pathology; interrelationship of severe asthma endotypes and COVID-19 disease mechanisms; severe asthma epidemiology and COVID-19; and biologics for severe asthma in the context of COVID-19. Results: COVID-19 disease mechanisms start with upper respiratory cell infection, and afterwards several immunological facets are activated, contributing to disease severity, namely cell-mediated immunity and antibody production. Although infrequent in the COVID-19 course some patients develop a cytokine storm that causes organ damage and may lead to acute respiratory distress syndrome or multiorgan failure. Regarding severe asthma endotypes, type2-high might have a protective role both in infection risk and disease course. There is conflicting data regarding the epidemiological relationship between COVID-19 among severe asthma patients, with some studies reporting increased risk of infection and disease course, whereas others the other way round. Biologics for severe asthma do not seem to increase the risk of infection and severe COVID-19, although further evidence is needed. Conclusions: Globally, in the era of COVID-19, major respiratory societies recommend continuing the biologic treatment, preferably in a self-home administration program. info:eu-repo/semantics/publishedVersion

Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a “one-size-fits-all” style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.

Lyme disease (LD) is an emerging zoonotic infection that is increasing in incidence in North America, Europe, and Asia. With the development of safe and efficacious vaccines, LD can potentially be prevented. Vaccination offers a cost-effective and safe approach for decreasing the risk of infection. While LD vaccines have been widely used in veterinary medicine, they are not available as a preventive tool for humans. Central to the development of effective vaccines is an understanding of the enzootic cycle of LD, differential gene expression of Borrelia burgdorferi in response to environmental variables, and the genetic and antigenic diversity of the unique bacteria that cause this debilitating disease. Here we review these areas as they pertain to past and present efforts to develop human, veterinary, and reservoir targeting LD vaccines. In addition, we offer a brief overview of additional preventative measures that should employed in conjunction with vaccination.

Problem setting. Ensuring the rights of workers to a safe working environment, the priority of their lives and health during their professional activity is the main goal of the state policy of Ukraine on occupational safety.However, in a pandemic, due to the significant spread of acute respiratory COVID-19 disease caused by the coronavirus SARS-CoV-2, the risk of infection of health care workers, especially those in direct contact with patients, is very high.According to the Center for Public Health of the Ministry of Health of Ukraine, for the period from the beginning of the pandemic to January 26, 2021, 1197,107 cases of coronavirus COVID-19 were recorded in Ukraine. As of January 26, 2021, 2,779 new laboratory-confirmed cases of coronavirus COVID-19 disease were recorded, of which 175 cases are those of medical workers. During the first 9 months of 2020, cases of infection with COVID-19 by medical and other workers whose work is related to the performance of professional duties in conditions of increased risk of infection, led to an increase in the number of reports of accidents/acute occupational diseases by 3.7 times, compared to the same period in 2019. In particular, for 9 months of 2020, 11,591 reports of accidents/acute occupational diseases of medical workers were registered, which is 71.2% of the total number of such reports.Recent research and publications analysis. The study of the main causes of occupational injuries, analysis of its state and consequences is reflected in the works of such researchers as A. Dengin, Y. Kundiev, O. Bodnarchuk and others. Researchers V. Averyanov, G. Astapova, G. Atamanchuk, V. Bakumenko devoted their work to the theory and practice of forming and implementing public policy. The solution of topical issues of the development of methods of monitoring the state of labor protection in Ukraine, to one degree or another, is covered in the works of the following domestic researchers: V. Afanasyev, G. Gogitashvili, A. Amoshi, and others. At the same time, it should be noted that the issue of investigating cases of COVID-19 didease of the healthcare professionals has not been investigated yet due to its novelty.Highlighting previously unsettled parts of the general problem. The paper objective is to analyze the theoretical and methodological approaches to investigating cases of COVID-19 disease among medical workers in the context of implementing the state policy on occupational safety. Paper main body. Following the recommendations of the Ministry of Health of Ukraine and the State Labor Service, laboratory-confirmed cases of COVID-19 infection of medical and other workers associated with the performance of professional duties in conditions of increased risk of COVID-19 infection are investigated as cases of acute occupational disease under the requirements of the Procedure for investigating and accounting of accidents, occupational diseases and accidents at work, approved by the Resolution of the Cabinet of Ministers of Ukraine of April 17, 2019, ¹ 337 (hereinafter the Procedure of Investigation), which determines the procedure for holding the investigation and accounting of accidents, occupational diseases and accidents at work. The Procedure of Investigation provides three types of investigation of acute occupational diseases: special investigation, investigation (general), investigation of acute occupationalCOVID-19 disease caused by coronavirus SARS-CoV-2, which led to a fatal outcome. Conducting any of the above types of investigation is preceded by:– emergency notification of the victim’s appeal about an acute occupational disease (according to Annex 1 to the Procedure of Investigation);– notification of the employer about an acute occupational disease (according to Annex 2 to the Procedure of Investigation).The investigation commission’s composition is determined by items 13, 15, 142 of the Procedure of Investigation and depends on the type of investigation. If the commission establishes the employee’s infection during the performance of professional duties, an acute occupational disease is recognized as related to production. In the context of the above-mentioned, it is important that a medical staff member is or is not included in the “List of positions of medical and other staff directly involved in the epidemic and measures to prevent the spread of acute respiratory COVID-19 disease caused by coronavirus SARS-CoV-2, and treatment of patients with cases of acute respiratoryCOVID-19 disease caused by coronavirus SARS-CoV-2”, approved by the Order of the Ministry of Health of Ukraine of July 15, 2020, ¹1604. By the investigation results, the commission is obliged to draw up an act on the form H-1 (according to Annex 11 to the Procedure of Investigation), which is subject to approval by the employer. The tasks of the investigation of acute occupational disease are, in particular, to determine the compliance of working conditions and safety with the requirements of labour protection legislation, clarifying the circumstances and the causal link between the acute occupational disease and the performance of professional duties of the victim. The Investigation Procedure does not regulate the procedure for classifying the disease as acute occupational but regulates the procedure for linking chronic disease (poisoning) with the working conditions of the employee by his requirements and the List of Occupational Diseases approved by the Cabinet of Ministers of November 8, 2000, ¹ 1662.The list of occupational diseases, in accordance with the Instructions for its use is the main document that should be followed when diagnosing an occupational disease, its connection with the work or profession. The diagnosis of an acute occupational disease that occurs at work is established by a doctor of any treatment and prevention facility after mandatory consultation with an occupational pathologist and an occupational health doctor; and in diseases of infectious origin – the diagnosis is established by an infectious disease doctor and occupational pathologist, taking into account the epidemiological investigation.There is no legal act in Ukraine that determines the procedure for conducting an epidemiological investigation. Instead, for registration of results of the epidemiological inspection, the form of the accounting statistical documentation 350/i “Map of epidemiological inspection of the centre of an infectious disease” approved by the Order of the Ministry of Health of Ukraine of July 11, 2000, ¹ 160 is applied. Conclusions of the research and prospects for further studies. According to the results of the investigation of acute occupational disease, which is duly reflected in the act of investigation of acute occupational disease in the form of H-1, victims of acute respiratory COVID-19 disease caused by coronavirus SARS-CoV-2 may be recognized as medical workers, who within the limits of their official duties, in compliance with the rules of labour protection and safety, following the order of the head of the health care institution, have directly provided medical care to patients with COVID-19, have worked with the pathogen COVID-19 or participated in disinfection measures in the conditions of compliance with the rules of infection control and the use of personal protective equipment. Since the act of investigation of acute occupational disease is made solely based on the epidemiological investigation of the case of infection of a health worker and the conclusion of an infectious disease specialist and occupational pathologist to establish a connection of acute respiratory COVID-19 disease caused by coronavirus SARS-CoV-2 with the professional activity, there is a need in legal regulating of: 1. Procedure for conducting an epidemiological investigation of epidemics and outbreaks of infectious diseases;2. Detailing the procedure for the investigation of acute occupational disease, in particular in the following part:– sending an emergency message and notifying the employer of acute occupational disease, namely – only after the appropriate diagnosis of acute occupational disease;– delimitation of powers and specification of conditions (criteria) for the formation of a commission of special investigation (whose competence includes the investigation of fatalities that caused serious consequences and group acute occupational diseases) and the commission of investigation of acute occupational COVID-19 disease caused by coronavirus 2 SARS-CoV, which led to a fatal outcome.Thus, implementing the state policy on occupational safety requires a conceptual approach to the rule-making process and stipulates the necessity for further scientific research.

Air pollution is a crucial risk factor for respiratory infection. However, the relationships between air pollution and respiratory infection based on pathogen detection are scarcely explored in the available literature. We detected respiratory infections through patient-based bacterial culture in sputum, obtained hourly data of all six pollutants (PM2.5, PM10, SO2, NO, CO, and O3) from four air quality monitoring stations, and assessed the relationships of air pollutants and respiratory bacterial infection and multi-drug-resistant bacteria. Air pollution remains a challenge for Mianyang, China, especially PM2.5 and PM10, and there are seasonal differences; pollution is the heaviest in winter and the lowest in summer. A total of 4237 pathogenic bacteria were detected, and the positive rate of multi-drug-resistant bacteria was 0.38%. Similar seasonal differences were found with respect to respiratory infection. In a single-pollutant model, all pollutants were significantly associated with respiratory bacterial infection, but only O3 was significantly associated with multi-drug-resistant bacteria. In multi-pollutant models (adjusted for one pollutant), the relationships of air pollutants with respiratory bacterial infection remained significant, while PM2.5, PM10, and O3 were significantly associated with the risk of infection with multi-drug-resistant bacteria. When adjusted for other five pollutants, only O3 was significantly associated with respiratory bacterial infection and the risk of infection with multi-drug-resistant bacteria, showing that O3 is an independent risk factor for respiratory bacterial infection and infection with multi-drug-resistant bacteria. In summary, this study highlights the adverse effects of air pollution on respiratory infection and the risk of infection with multi-drug-resistant bacteria, which may provide a basis for the formulation of environmental policy to prevent respiratory infections.

Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE.We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed.We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26-3.03) and female gender (HR = 2.08, 95%CI 1.12-3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39-13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06-0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04-3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21-2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26-0.93) and female gender (HR = 5.12; 95%CI 1.62-16.18) with higher risk of bacterial infection.The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection. Key Points • Lupus patients treated with prednisolone ≥ 7.5 mg/day were 89% more likely to present infections. • Lupus patients receiving prednisolone ≥ 10 mg/day were four times more likely to present serious infections. • Lupus patients receiving antimalarials were 82% less likely to present serious infections.

In November 2018, a tularaemia outbreak occurred in Bavaria, Germany, among participants of a hare hunt and butchery employees handling the hares. We conducted an epidemiological outbreak investigation, including a retrospective cohort study among hunting participants, to identify likely transmission routes and activities associated with infection. Twelve of 41 participants were antibody-positive for Francisella (F.) tularensis (attack rate: 29%). Cases reported influenza-like symptoms (n = 11), lymphadenopathy (n = 1) and conjunctivitis (n = 1). Infection only occurred in those hunting participants present while hares were processed, while risk of infection was highest when directly involved (RR = 10.0; 95%CI: 2.6-392). F. tularensis was isolated from 1/4 hares. Only two individuals reported using some of the recommended personal protective equipment (PPE). Occurrence of mainly non-specific symptoms, likely due to early treatment, was not indicative of a specific transmission route. Transmissions via direct (skin/mucosa) contact and by inhalation of contaminated aerosols seem plausible. Promoting and increasing appropriate use of PPE among people processing hares is crucial to prevent future outbreaks.

Sexually transmitted diseases (STDs) have been known about since ancient times. Today, however, STDs are on the rise in young people around the world. Interventions and sex education are being utilized in attempt to prevent STD spread in individuals who are the greatest risk of infection. Young people should be provided with easy and accessible health services. There should be anonymity as well as investigations into the reasoning behind unsafe behavior.

The study developed a set of universal challenges for social workers and investigated the impact thereof on social workers in the United Arab Emirates (UAE). Based on a qualitative analysis of previous research, a set of 10 universal challenges was developed. A questionnaire was created, and a survey was conducted among 304 respondents currently employed as social workers in the UAE. The survey results showed that most survey respondents selected the risk of infection as the strongest challenge. Emotional burnout, lack of reliable information, limited resources, staff capacity, problems with social distancing, lack of instructions/protocols, remote client service, and inadequate education obtained average scores meaning that they are important but not critical. Scientists and practitioners can use this set of universal challenges to investigate pandemic-related challenges for social workers in various countries and regions.

Patients and health workers were at high risk of infection during the Sars-Cov-2 pandemic lockdown. For this reason, other medical and clinical approaches such as Telemedicine were necessary. Despite Telemedicine was born before COVID-19, the pandemic was the opportunity to accelerate a process already underway for at least a decade and to blow all the barriers away. Our aim is to describe the experience of Telemedicine during and immediately after the first lockdown to assure the follow-up in a 'virtual' outpatient clinic dedicated to Rheumatic and Musculoskeletal Diseases (RMDs) and to give an overview of Telemedicine in the rheumatology field. We retrospectively evaluated the patient flow to our rheumatology division from March to September 2020 and, in accordance with local restrictions, three periods were selected. In the 1st period, 96.96% of the outpatient clinic cases were shifted to Telemedicine; these decreased to 52.45% in the 2nd period, while the 3rd period was characterized by the return of the patients at the clinic (97.6%). Diagnostic procedures were postponed during the 1st period, reduced drastically during the 2nd and performed regularly during the third period. Intravenous infusions were maintained as much as possible during the three periods, to assure therapeutic continuity. Shifting stable patients to Telemedicine has the potential to allow continuity of care, while reducing the risk of contagion during a pandemic. In the next future, the integration of Telemedicine as standard of care for specific clinical applications might assure assistance for RMDs patients also in non-pandemic conditions.

Background Seasonal influenza can circulate in parallel with coronavirus disease (COVID-19) in winter. In the context of COVID-19 pandemic, the risk of co-infection and the burden it poses on healthcare system calls for timely influenza vaccination among pregnant women, who are the priority population recommended for vaccination. We aimed to evaluate the acceptance of influenza vaccination and associated factors among pregnant women during COVID-19 pandemic, provide evidence to improve influenza vaccination among pregnant women, help reduce the risk of infection and alleviate the burden of healthcare system for co-infected patients. Methods We conducted a multi-center cross-sectional study among pregnant women in China. Sociodemographic characteristics, health status, knowledge on influenza, attitude towards vaccination, and health beliefs were collected. Locally weighted scatterplot smoothing regression analysis was used to evaluate the trends in the acceptance of influenza vaccine. Logistic regression was applied to identify factors associated with vaccination acceptance. Results The total acceptance rate was 76.5% (95%CI: 74.8–78.1%) among 2568 pregnant women enrolled. Only 8.3% of the participants had a history of seasonal influenza vaccination. In the logistic regression model, factors associated with the acceptance of influenza vaccine were western region, history of influenza vaccination, high knowledge of influenza infection and vaccination, high level of perceived susceptibility, perceived benefit, cues to action and low level of perceived barriers. Among 23.5% of the participants who had vaccine hesitancy, 48.0% of them were worried about side effect, 35.6% of them lacked confidence of vaccine safety. Conclusions Our findings highlighted that tailored strategies and publicity for influenza vaccination in the context of COVID-19 pandemic are warranted to reduce pregnant women’s concerns, improve their knowledge, expand vaccine uptake and alleviate pressure for healthcare system.

Purpose of Review Nutritional status is affected by the COVID-19 pandemic, directly or indirectly. Even with the recent rollout of the coronavirus disease 2019 (COVID-19) vaccines and availability of medicines such as remdesivir, and monoclonal antibodies, host nutritional status is pivotal in the fight against the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and outcomes. The purpose of this review is to discuss the effects of COVID-19-related lockdown on lifestyle behaviors, and the nutritional consequences, and the direct sequelae of the infection on nutrition including potential nutritional interventions. Recent Findings The COVID-19-related lockdown imposed radical changes in lifestyle behaviors with considerable short-term and long-term health and nutritional consequences including weight gain and obesity and increased cardiometabolic risk, consistently linked to worsened prognosis. The extent of the impact was dependent on food insecurity, overall stress and disordered eating, physical inactivity, and exposure to COVID-19-related nutrition information sources. COVID-19 could directly induce inflammatory responses and poor nutrient intake and absorption leading to undernutrition with micronutrient deficiencies, which impairs immune system function with subsequent amplified risk of infection and disease severity. Nutrition interventions through nutrition support, dietary supplementation, and home remedies such as use of zinc, selenium, vitamin D, and omega-3 fatty acids showed the most significant promise to mitigate the course of COVID-19 infection and improve survival rates. Summary The nutrition-COVID-19 relationship and related dietary changes mimic a vicious cycle of the double burden of malnutrition, both obesity and undernutrition with micronutrient deficiencies, which promote infection, disease progression, and potential death.

Background: Coronavirus disease 2019 (COVID-19) cases in Germany, as in most other places in Europe or worldwide, are still highly prevalent. Vaccination rates currently remain low, putting cancer patients at a continued risk of infection with SARS-CoV-2, while prevalence of SARS-CoV-2 antibodies among cancer patients in Germany remains essentially unknown. Methods: Between August 2020 and February 2021, patients admitted to our hospital were prospectively enrolled in our COVID-19 biobank. Collected sera were analyzed for SARS-CoV-2-IgM/IgG using Elecsys Anti-SARS-CoV-2 assay. Results: One hundred and ten patients with cancer were included in this study. With 71 (65%) patients, most had active cancer treatment, mainly chemotherapy (56%). The most frequent diagnosis was gastrointestinal cancer (54%) with pancreatic cancer being the most common cancer type (24%). Hematologic malignancies were present in 21 patients (17%). Among the cancer patients first diagnosed during the pandemic, the rate of palliative treatment situations tended to be higher (76% vs. 67%, p = 0.17). A history of SARS-CoV-2 infection was documented in 15 (14%) patients; however, SARS-CoV-2 antibodies were detected in 10 (67%) patients only. Of the patients without a history of SARS-CoV-2 infection, none displayed SARS-CoV-2 antibodies. Conclusion: In the present single-center experience, a low serological prevalence of SARS-CoV-2 antibodies among cancer patients even after SARS-CoV-2 infection was found. The results support continued strict preventive measures as well as efforts toward faster vaccination, due to a low immunity level in the population.

Background The COVID-19 disease has overwhelmed and disrupted healthcare services worldwide, particularly healthcare workers (HCW). HCW are essential workers performing any job in a healthcare setting who are potentially directly or indirectly exposed to infectious materials. Our retrospective cohort study aimed to determine the prevalence of COVID-19 infections among HCW in Jakarta and neighbouring areas during the first three months of the pandemic. Methods Nasopharyngeal/oropharyngeal swab specimens from HCW working at private and public hospitals in Jakarta and neighbouring areas were screened for SARS-CoV-2 between March and May 2020. Data on demography, clinical symptoms, contact history, and personal protective equipment (PPE) use were collected using standardised forms. Results Among 1201 specimens, 7.9% were confirmed positive for SARS-CoV-2 with the majority coming from medical doctors (48.4%) and nurses (44.2%). 64.2% of the positive cases reported to have contact with suspect/confirmed COVID-19 cases, including 32 (52.2%) with patient and 3 (6.6%) with co-worker. The symptomatic HCW had a significantly lower median Ct value as compared to their asymptomatic counterpart (p

Resumen La infeccion por SARS-CoV-2 ha evolucionado hasta convertirse progresivamente en una pandemia y en una emergencia de salud publica de importancia internacional que ha obligado a las organizaciones de salud a nivel mundial, regional y local a adoptar una serie de medidas para hacer frente a la COVID-19 e intentar disminuir su impacto, no solo en el ambito social sino tambien en el ambito sanitario, modificandose las pautas de actuacion en los servicios de salud. Dentro de estas recomendaciones, que incluyen las unidades de tratamiento del dolor, los pacientes con sospecha o infeccion confirmada por SARS-CoV-2 pueden encontrase en situacion de espera para consulta medica o tecnicas invasivas para el manejo de dolor cronico refractario a otras terapias. Se recogen en este manuscrito una serie de pautas encaminadas a disminuir el riesgo de infeccion del personal de salud, de otros pacientes y de la comunidad.

Although it is commonly known that viruses cannot multiply in food as they need a living host for growth, adenoviruses and corona viruses can reportedly survive on surfaces and food packages for several days. Therefore, food item mishandling could increase the risk of infection. In this cross-sectional study, we assessed the changes in the food purchasing habits, food safety behavior, and food handling practices among Saudi women during the COVID-19 pandemic. The study included 1356 women who were randomly approached via convenience sampling using an anonymous questionnaire distributed through various social media platforms. The variables were described in terms of frequency and percentage, and the Chi-square test was applied to assess the relationship between the dependent and independent variables. Approximately 62.5% of the participants were aware that SARS-CoV-2 is not transmitted via food. Most participants (90%) reported a shift from outdoor to indoor meal preparation, along with avoidance of visits to grocery stores for food purchase (55%) and increased usage of online grocery delivery services (27%). Most participants obtained good overall scores for food safety behavior during grocery shopping (mean score: 10.83±1.62/12 points, 90.25%), grocery unpacking at home (10.60±2.65/13 points, 81.55%), and personal hygiene (28.84±3.16/36 points, 80%). However, a moderate overall score was obtained for food preparation practices (7.77 ±1.91/12 points, 77.7%). Older and/or retired individuals, patients with chronic diseases, and/or individuals living with children showed better food safety behavior and handling practices compared to their counterparts. This study reported good overall food safety behavior and handling practice scores among participants under most categories studied. However, our results highlight the need for more customized public education programs for Saudi women, who are the primary food handlers in most households, particularly during food preparation, to further improve food safety practices and prevent potential food mishandling, which will eventually help preventing the spread of COVID-19.

Aims: The Paper will explore about the COVID- 19 social challenges confronted by the Rohingya refugees in Cox’s Bazar of Bangladesh and will also discuss the role of India in providing medical assistance to Rohingyas in Bangladesh and further will explain a set of policy recommendations designed to improve the life chances of the Rohingya community both now and in the future. Study Design: Descriptive Study. Methodology: A detailed and related Review of literature of the previous work has been collected in order to extract the information about the vulnerable conditions of Rohingyas refugees in Bangladesh amid novel coronavirus. The paper is based on qualitative research design and the data has been collected from official reports, documents, newspaper, journal articles, books based on Rohingyas refugees in Bangladesh. Results: The COVID-19 pandemic represents a grave social threat to the Rohingya refugees in the camps of Bangladesh. Having fled decades of persecution by the Burmese military, the majority of Rohingya currently live in densely populated refugee camps in Bangladesh. Most are denied access to the internet, mobile phones, humanitarian aid, and sanitary conditions and living in congested camps—all of which heighten the risk of infection and contamination. Currently in 2021, Government of India and International Organization are providing COVID- 19 vaccines and medical assistance to Rohingyas in Bangladesh. Conclusion: Despite facing social impact from COVID- 19, Government of India are taking imperative steps, both to protect the Rohingya from widespread infection and to create the conditions whereby future tragedy can be preempted.

Purpose The pandemic SARS-CoV-2 poses new and unprecedented challenges for health care systems on a national and global level. Although the current situation has been going on for more than 1 year, there is limited data on the impact of the pandemic on general hospital and medical practice care. This survey captures the perspective of patients with gynaecological diseases of this impact. Methods Using a paper-based questionnaire, 327 patients were asked about medical care and their experiences during the pandemic at the University Hospital Bonn and the University Hospital Charité Berlin. The study was performed from the 1st June to 30th September 2020. Results A total of 327 patients participated in the study: 156 stated to have been tested for coronavirus, and 1 patient reported a positive test. 41.3% of the patients felt insecure about the current situation, 30.4% were concerned about the risk of infection during the hospital stay. The pandemic-specific measures in hospitals and medical practices unsettled 6.8% of patients. 18.1% of patients feared that their gynaecological disease would not be treated adequately due to the pandemic. 55.7% of patients reported that their confidence in their physicians has increased during the pandemic. Conclusion The results show that patients’ confidence in the healthcare system and the physicians acting significantly increased during the COVID-19 crisis. Transparent and comprehensive information policy regarding actions and restrictions within the COVID-19 crisis eases patients concerns and improves patients’ confidence in their physicians, which is crucial for a successful treatment’s outcome.

Background.The COVID-19 epidemic in the Russian Federation, which began in March 2020, caused serious damage to health of the population and led to severe economic losses. By December 28, 2020, 3 078 035 cases of COVID-19 and 55 265 lethal outcomes were registered in the country. The population of all territorial subjects of the country is involved in the epidemic process of COVID-19. The severe epidemiological situation made it necessary to conduct an analysis to identify the factors that determine the high intensity of the epidemic process, as well as the population groups with the highest risk of SARS-CoV-2 infection. Aims to study the patterns of SARS-CoV-2 spread and the epidemiological features of the initial stage of the COVID-19 pandemic in the Russian Federation in 2020. Methods.An epidemiological analysis of the COVID-19 situation in the Russian Federation was carried out to determine the dynamics of morbidity, the gender proportion and age structure of patients, the proportion of hospitalized patients, the ratio of various forms of infection, the social and professional status of patients. Standard methods of descriptive statistics Microsoft Excel and STATISTICA 12.0 (StatSoft, USA) were used for statistical processing. The mean values were estimated with a 95% confidence interval [95% CI] (the exact Klopper Pearson method). Results.During the observation time (2020), several periods were identified in the dynamics of the new COVID-19 cases detection: the period of importation of SARS-CoV-2 and the increase in morbidity, the period of epidemic decline, the period of autumn growth, the period of sustained high incidence of COVID-19. It was found that people over 70 years of age are the group with the highest risk of infection and a more severe course of COVID-19. The presence of target contingents among social and professional groups of the population, which should include medical workers, retired person, employees of educational institutions, law enforcement agencies, transport, who require special attention and medical and social support, was shown. Conclusions.The analysis showed that the large-scale spread of COVID-19 requires in-depth epidemiological studies and the development of additional disease control measures, taking into account the dynamics of the incidence of this socially significant infection.

The present study aimed to explore the opportunities for the sustainable development of professional sports enterprises and events from the perspective of the public’s awareness, attitude, and behavior, as well as the physical and mental health of the spectators of professional events in Taiwan. First, 1,129 valid questionnaires were collected and analyzed by statistical, t test, and ANOVA methods. In addition, 9 respondents were interviewed to provide their personal opinions on the questionnaire results, and finally, multivariate analysis was conducted. Sports entrepreneurs must follow the decision to prevent the epidemic, make good use of Internet technology, plan a complete process, and use accurate testing facilities to grasp the movements of participants. They will win public recognition to maintain professional sports companies and events in COVID-19 and normal operation under the epidemic and create a sustainable environment for professional sports companies and events.

Objective: Frontline healthcare workers are the first line of defense against Covid-19, resulting in a higher risk of infection. The objective of this study was to describe the impact of the SARS-CoV-2 infection and its associated risk factors among professionals working in a healthcare consortium that includes different centers. Methods: This was a retrospective analytical observational study of 2620 healthcare workers; the project period began with the declaration of the state of alarm in Spain (March 15, 2020) and ended on June 21, 2020. We estimated associations between the independent variables sex, age, seniority, professional category and work location and confirmed COVID-19 as the outcome variable. Bivariate study analysis was based on chi-square test and simple logistic regression with calculation of the odds ratio (OR) and 95% confidence interval (95%CI). Multivariate analysis was performed using multiple logistic regression. Statistical significance was set at p ≤0.05. Results: All frontline healthcare worker categories were at higher risk than non-patient-facing personnel. Nurses had the highest risk [OR, 14.03 (3.19-61.66)]. With respect to work location, and as compared to non-patient-facing personnel, working in the surgical-medical-hospitalization-clinic [OR 13.43 (1.7-106.12)] and socio-health center [OR 17.77 (2.19-144.04) posed the greatest risks. Conclusions: The greatest risk of acquiring COVID-19 was among patient-facing healthcare professionals working in areas where COVID-19 was detected among patients admitted for other pathologies. This risk was higher than in those areas designated for the care of COVID-19 patients, possibly due to differences in the use of personal protective equipment.

BACKGROUND AND AIM OF STUDY There exists controversy regarding the impact of infection in patients with a left ventricular assist device (LVAD) on post-heart transplant outcomes. This study evaluated the association between infections during LVAD support and the risk of early and late post-heart transplant infection, rejection, and mortality in transplant recipients bridged with an LVAD. METHODS This is a single-center retrospective observational cohort study of consecutive adults supported with a continuous flow LVAD undergoing heart transplant between 2006 and 2019 at the Toronto General Hospital. The grade of LVAD infection was classified as per International Society of Heart and Lung Transplantation guidelines. Patients were divided into three groups: (1) patients with LVAD-specific infection confirmed with positive cultures requiring long-term antibiotic use until the time of transplant; (2) patients with any type of infection in whom antibiotics were stopped at least 1 month before transplant; (3) patients without any infections between LVAD implant and transplant. Logistic regression and Cox proportional hazard models were used to evaluate early- and late-post transplant outcomes, respectively. RESULTS We included 75 LVAD recipients: 16 (21%) patients had a chronic LVAD-related infection on suppressive antibiotics, 30 (40%) had a resolved infection, and 29 (39%) had no infections. During a median post-transplant follow-up time of 4 (2 to 7) years, 65 (87%) patients developed infections, 43 (64%) rejections, and 17 (23%) deaths. Both short- and long-term risks of infection, rejection, and mortality did not differ significantly among the groups. CONCLUSION LVAD patients with infections did not have a significantly higher risk of infection, rejection, or mortality at any time point after transplant.

Introduction: in the review, we aimed to present current knowledge about the risk of infection, standards of care, and postexposure prophylaxis (PEP) in pediatric patients after non-vertical exposures to HIV, HBV, and HCV infection. Materials and Methods: the latest available literature and recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), European recommendations for the management of HIV and administration of non-occupational PEP, and Polish AIDS Society were reviewed. Results: the majority of cases of non-vertical exposure to blood-borne viruses in the pediatric population consist of sexual exposition and injection with unsterilized sharp objects (usually needlestick injuries). The risk HIV, HBV, and HCV transmission depend on several factors, and each exposure should be evaluated individually with consideration of the patient’s medical history. It is crucial to start antiretroviral therapy within 48 h from exposure. Treatment is continued for 28 days, and a 3-drugs regiment is recommended in the majority of cases. Decisions on hepatitis B and tetanus PEP are based on a history of vaccination. There is no PEP for hepatitis C infection, follow-up testing aims for early identification of disease and consideration of treatment options. Conclusion: all children after the non-vertical exposure to HIV, HBV, and HCV infection should be evaluated by the Infectious Disease specialist as soon as possible after the incident and qualified to post-exposure prophylaxis. Systematic diagnostic and follow-up on children after significant needlestick exposure should be maintained. Children after sexual exposure need a multidisciplinary approach. Response to reported event must be rapid and treatment must be comprehensive.

Background Immunoglobulin A (IgA) is an important component of the early immune response to SARS-CoV-2. Prior serosurveys in high-risk groups employing IgG testing alone have provided discordant estimates. The potential added benefit of IgA in serosurveys has not been established. Methods Longitudinal serosurvey of first responders (police, emergency medical service providers, fire fighters, and other staff) employing 3 serologic tests (anti-spike IgA, anti-spike IgG, and anti-nucleocapsid IgG) correlated with surveys assessing occupational and nonoccupational risk, exposure to COVID-19, and illnesses consistent with COVID-19. Results Twelve percent of first responders in Colorado at baseline and 22% at follow-up were assessed as having SARS-CoV-2 infection. Five percent at baseline and 6% at follow-up were seropositive only for IgA. Among those IgA positive only at baseline, the majority (69%) had a positive antibody at follow-up; 45% of those infected at baseline and 33% at follow-up were asymptomatic. At all time points, the estimated cumulative incidence in our study was higher than that in the general population. Conclusions First responders are at high risk of infection with SARS-CoV-2. IgA testing identified a significant portion of cases missed by IgG testing and its use as part of serologic surveys may improve retrospective identification of asymptomatic infection.

BACKGROUND Maternal mortality remains high, despite all the advances and efforts that have occurred in recent years and is directly related to the quality of care provided during pregnancy, childbirth, and in the puerperium. PURPOSE Identify the possible nursing diagnoses of mothers of newborns admitted to neonatal intensive care in the prepartum period, childbirth, and the puerperium. METHODS Observational, cross-sectional study carried out by analyzing the medical records of mothers of newborns who required hospitalization in neonatal intensive care and determining the diagnoses through a process of diagnostic inference, based on NANDA-I Taxonomy, during the period from 2007 to 2016. FINDINGS After reviewing the medical records of 272 mothers, a total of 3,843 observations were identified, distributed in 42 diagnoses, with Excessive fluid volume presenting the greatest predictive power over the outcome variable. The second group of more predictive variables comprised the Risk of vascular trauma, Risk of infection, Impaired parenthood, and Risk of body temperature imbalance. The third group, in turn, consisted of the following diagnoses: Insomnia, Pain during labor, Risk of impaired bonding, Acute pain, and Ineffective Breastfeeding. CONCLUSIONS The present study enabled the identification of the most frequent NANDA-I nursing diagnoses occurring during the prepartum period, childbirth, and the immediate puerperium of mothers of newborns admitted to neonatal intensive care, as well as those of greatest importance. Based on the encountered diagnoses, it can be concluded that future studies should be carried out in order for validation. IMPLICATIONS The knowledge of these diagnoses can contribute to the instrumentalization of nursing professionals, with consequent improvements in the nursing process and the provided assistance, aiming to assist in the reduction of maternal morbidity and mortality.

Background: COVID-19 disease has quickly become a pandemic because of high infectiousness among populations. In order to assess for infectiousness reproduction numbers have been widely used in existing literature. A recent research has estimated reproduction numbers by location in order to account for differences among infectiousness. Aims and Objective: The aim of the present work was to use reproduction numbers in order to obtain an estimate for the mean number of contacts of some patient up to the first transmission of the disease to some other person in a specific location. The objective is to help authorities collect even more information on disease transmission. Materials and Methods: Our study was based on results obtained in a recent research work where replicated values of reproduction numbers have been generated in order to estimate medians and 95% confidence intervals for these numbers and thus assess infectiousness. We proposed a method that relies on a geometric distribution such that the parameter for this distribution is related to these reproduction numbers. Results: Our method showed that large reproduction numbers were associated with small mean numbers of contacts up to first transmission of the disease whereas small reproduction numbers were associated with a large mean number of contacts up to first transmission of the disease for all the locations under investigation. Conclusion: Our method has shown a nice performance and thus it can be considered as an alternative tool, by comparison with reproduction numbers, for assessing the risk of disease transmission, which is particularly useful when locations are investigated separately. [ABSTRACT FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Novel coronavirus disease 2019 (COVID-19) vaccine administration has faced distribution barriers across the United States. We sought to delineate our vaccine delivery experience in the first week of vaccine availability, and our effort to prioritize employees based on risk with a goal of providing an efficient infrastructure to optimize speed and efficiency of vaccine delivery while minimizing risk of infection during the immunization process. Objective This article aims to evaluate an employee prioritization/invitation/scheduling system, leveraging an integrated electronic health record patient portal framework for employee COVID-19 immunizations at an academic medical center. Methods We conducted an observational cross-sectional study during January 2021 at a single urban academic center. All employees who met COVID-19 allocation vaccine criteria for phase 1a.1 to 1a.4 were included. We implemented a prioritization/invitation/scheduling framework and evaluated time from invitation to scheduling as a proxy for vaccine interest and arrival to vaccine administration to measure operational throughput. Results We allotted vaccines for 13,753 employees but only 10,662 employees with an active patient portal account received an invitation. Of those with an active account, 6,483 (61%) scheduled an appointment and 6,251 (59%) were immunized in the first 7 days. About 66% of invited providers were vaccinated in the first 7 days. In contrast, only 41% of invited facility/food service employees received the first dose of the vaccine in the first 7 days (p Conclusion We developed a system of early COVID-19 vaccine prioritization and administration in our health care system. We saw strong early acceptance in those with proximal exposure to COVID-19 but noticed significant difference in the willingness of different employee groups to receive the vaccine.

Objectives: Population‐specific studies of vaccine uptake in pregnancy are necessary to monitor progress and ensure enablers to vaccination are locally relevant. We aimed to determine the uptake of influenza and pertussis vaccine during pregnancy in women in south‐east Queensland and the reasons why women were choosing not to vaccinate. Methods: A secondary analysis of data collected in a prospective cohort study. Data were collected at enrolment during pregnancy and within six weeks of giving birth. The primary outcome was the proportion of women vaccinated during pregnancy. Results: Among 310 pregnant women, 45.8% and 69.7% were vaccinated against influenza and pertussis, respectively; 123 (39.7%) had received both vaccines. The common predictor of vaccine uptake for influenza, pertussis or both was having had any vaccine in the 12 months prior to pregnancy. Not considering the vaccines necessary and perceptions of the risk of infection were common reasons for not intending to vaccinate. Conclusions: Antenatal vaccine uptake remains suboptimal in women in south‐east Queensland. Barriers to vaccination during pregnancy are complex and vary depending on context and population. Implications for public health: More efforts are needed to promote antenatal uptake, particularly for influenza vaccine and having both the influenza and pertussis vaccines during pregnancy.

Severe fever with thrombocytopenia syndrome (SFTS) was first detected in China in 2009. The incidence of SFTS increases year by year, and there is no effective treatment. Considering that the reported prevalence of SFTSV infection varies from region to region, we aimed to quantitatively evaluate the epidemic characteristics of SFTSV infection in China from 2010 to 2020, including the distribution differences in infectious season, sex, age, occupation, and region. A meta-analysis framework was used to search for the related published data with keywords in electronic databases (CNKI, Wanfang, CBM, and PubMed). According to the PRISMA statement, the studies that included SFTS diagnosed in China were analyzed. Furthermore, we used Revman and Stata to merge statistical effects, and used I2 and P-values for heterogeneity test and quality assessment. Eleven studies containing 4,932 cases confirmed by SFTSV infection were included in this meta-analysis. The ratio of male-to-female is 1.04 to 1. Cases were concentrated between 40 and 80 years of age (MD = 92%, 95%CI: 91%–93%). Farmers are at the highest risk of SFTSV infection (MD = 84%, 95%CI: 77%–90%). The risk of infection for consecutive period of April-August was significantly higher than the sum of the remaining months (MD = 82%, 95%CI: 78%–85%). In addition, the patient has an extensive history of exposure, including living in the mountains, exposure to ticks, livestock, mouse and the patient. We came to the conclusion that SFTSV is transmitted primarily through tick bites in China, so middle-aged and older adults living in mountains regions are at the highest risk for SFTSV infection in April through August each year.

Sara M Esmat,1 Mohammad R Aboulfotouh,1 Moushira H Ezzelarab,2 Shaimaa A Abdalgeleel,3 Doaa A Tolba1 1Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Biostatistics and Epidemiology, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Sara M EsmatDepartment of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, 11562, EgyptTel +201069186501Email dr.sara_mamdouh@hotmail.comIntroduction: Ophthalmologists are at a high risk of coronavirus disease 2019 (COVID-19) infection owing to their working environments and proximity to patients during examinations. Compliance with infection control measures in examination offices can lessen the risk of infection to this group. In Egypt, several deaths from COVID-19 have been reported among ophthalmologists; therefore, we studied the prevalence of COVID-19 infections in this group and assessed ophthalmologists’ commitments to recommended infection control measures.Aim: To evaluate the rate of COVID-19 infections among ophthalmologists, identify risk factors for infections, and evaluate ophthalmologists’ commitments to infection control measures in their medical facilities.Methods: An online questionnaire was designed and distributed to ophthalmologists in the Cairo Governorate from May 1, 2021 to mid-June 2021.Results: Out of 161 responders, the percentage of COVID-19 infections was 52.8% (85 responders). This was significantly higher among younger ophthalmologists (P-value = 0.019) and those with fewer years of experience (P-value = 0.010). Adopting full precautions while examining patients with or without respiratory illness were significantly associated with a lower infection rate (P-value = 0.019 and 0.046, respectively). A significantly higher infection rate was reported for ophthalmologists who examined known COVID-19 patients at outpatient clinics, even when taking precautions (P-value = 0.032). A lower rate of COVID-19 infection was significantly associated with adopting full precautions while operating on suspected or nonsuspected COVID-19 patients (P-value = 0.007 and 0.003, respectively).Conclusion: Both young age and limited experience were significant infection risk factors in our study. The most important infection control measures that significantly decreased infection risks were adherence to full protective measures while working in outpatient clinics and operating rooms.Keywords: COVID-19, infection control, ophthalmologists

Background: Hepatitis C virus [HCV] infection is a global health problem. Children with certain risk factors are at high risk of infection.Objective: The present study aimed to evaluate the prevalence of HCV among high-risk Egyptian children.Methods: The study included 1357 children aged 3-15 years with risk factors of HCV including receiving blood products, hemodialysis, previous surgical intervention, insulin therapy and positive family history. They were subjected to careful history taking, thorough clinical examination and routine laboratory investigations. All children were tested for HCV antibodies using commercial 4th generation enzyme-linked immunosorbent assay [ELISA] kits. Those with positive results were further assessed using polymerase chain reaction [PCR].Results: Among the studied patients, there were 89 children [6.6 %] with positive HCV Ab and 73 children [5.4 %] with positive PCR test for HCV. Using multivariate logistic regression, significant predictors of HCV infection in the studied children were blood transfusion [OR: 1.23, CI: 0.019-13.4], Intravenous [IV] injection [OR: 10.962, CI: 1.937-62.026] and previous operation [OR: 3.12, CI: 1.046-31.6].Conclusion: HCV infection is highly prevalent among high-risk children. Blood transfusion, IV injection and exposure to surgery are independent risk factors for infection in this population.

Introduction: In the COVID-19 pandemic process, the health of healthcare workers with a high risk of infection is critical. Many healthcare workers have become infected while serving COVID-19 patients, and they have also been and are still exposed to the disease agent at hospital, household or community-based. The aim of this study was to determine the risk status of healthcare workers in contact with COVID-19 patients working at Manisa Celal Bayar University Hospital, and to reveal COVID-19 surveillance and related results. Materials and Methods: This descriptive study was based on examining the data of healthcare workers (HW) that came in contact with the disease between 1 April and 31 December 2020 to the COVID-19 Surveillance Unit (SU), which was established by Manisa Celal Bayar University Public Health Department during the pandemic process. Results: Among the in-contact health workers;65.7% were females, 42.5% were nurses and 26.0% were physicians. 23.8% of the contacts were high, 42.9% medium and 33.3% low risk. High risk contact percanteges were statistically higher in the emergency unit personal, laboratory workers and household/community based contacts (p= 0.000). PCR positivity rate was 10.1% in high risk contact and 3.6% in medium risk contact (p= 0.000). During the research period, the rate of COVID-19 positivity in healthcare workers at Manisa Celal Bayar University Hospital was determined as 21.9% (n= 374). In the study, 24.9% of COVID-19 positive healthcare workers were physicians and 29.0 % were nurses. Conclusion: 23.8% of HCW were evaluated as high risk contact and 21.9% of the group tested positive. High risk contact percanteges were statistically higher in the emergency unit personal, laboratory workers and household/community based contacts. Protecting healthcare workers from infection in the fight against pandemics and performing contact follow-ups are also vital for continuity of service.

Hand, foot, and mouth disease (HFMD) infected with Coxsackievirus A6 (CV-A6) have demonstrated an increasing trend in China. Our study aimed to explore the risk factors of HFMD cases infected with CV-A6 in children under 6 years of age in Tianjin, China. A non-matching case-control study was conducted in Tianjin, China. Cases were HFMD patients infected with CV-A6 while controls were HFMD patients infected with other enteroviruses. Multivariate logistic regression analysis was used to explore the risk factors of HFMD cases infected with CV-A6. A total of 1,264 eligible cases were included in our study, including 589 cases and 675 controls. Our study indicates that the CV-A6 caused HFMD patients were more likely to present with fever and rash on limbs, and home-care children and children having a history of contacting HFMD patient had a high risk of infection with CV-A6, while toy sterilization regularly at home and parents' hand-washing habits after toilet use were the protecting factors for children against CV-A6 infection.

Background: SARS-CoV-2 infection (COVID-19) is clinical threat to healthy individuals around the world. Risk of disease and related complications are high among immunocompromised individuals and those with pre-existing chronic diseases. Aim: To assess the fear of Covid-19 among patients having chronic diseases and to determine its relationship with preventive practices among them. Study Design: Cross-sectional study Place and Duration of Study: Department of Community Medicine, HITEC Hospital Taxila from 1st September2020 to 31st March 2021. Methodology: Three hundred and seventeen patients having chronic diseases were included. Fear of Covid-19 scale used to assess the fear level and questions related to preventive practices. Results: Fear of Covid-19 was high among females, hypertensive, diabetics and those having cardiovascular disease. Fear was found among 133 (42%) participants. Regarding Covid-19 preventive practices, 8(2.5%) had unsatisfactory, 115 (36.3%) had satisfactory and 194(61.2%) had good preventive practices. Covid precautions were significantly practiced among those having fear. Statistically significant positive correlation was found between mean Covid fear and practices scores (r=.30, p=.001) Conclusion: Fear of Covid is a recognized risk factor for anxiety and depression among people. However, fear is found to promote risk perception and health related preventive behaviors among chronic patients that can positively ensure safety, decrease the risk of infection and serious complications among chronic patients. Keywords: SARS-CoV-19, Fear for Covid-19, Preventive Practices, Chronic diseases.

During the COVID-19 pandemic, China has implemented the most stringent lockdown measures across major cities during moments of heightened risk of infection. This mechanism is aided by the mandated Health QR Code to surveil and contain spread of the virus. This research scrutinizes the varying degrees and forms of disconnect in the context of the Health Code mandate. Informed by extensive focus group interviews of diverse resident groups, supplemented with thematic analysis of 136 newspaper news stories covering the enforcement of the Health Code, the research results offer insight over the multiplicity of voluntary and involuntary disconnective practices at both the individual/internal and societal/external level. These findings are contextualized for their theoretical relevance towards the overall line of inquiry into information technology non-use, and the pragmatic implications of the Health Code are discussed for contact tracing app design and utility in general.

In modern conditions, the burden on the staff of medical institutions has increased many times. This is due to the fact that for more than a year and a half, the planet has been overwhelmed by waves of the coronavirus pandemic. Having come from China, this virus spread like lightning across the planet, causing an economic crisis, violation of the usual foundations of human life, etc. However, despite the undulating incidence of COVID-19 and a significant number of cases, other diseases and medical emergencies also occur, and doctors need to provide patients with the necessary assistance. It should be said that, despite the high level of protective measures in medical institutions, the provision of emergency medical care to patients is associated with a certain risk for doctors, since assistance should be provided to such patients immediately, and it is not always possible to quickly assess whether they are carriers of the virus, unfortunately. For this reason, the risk of infection to medical workers providing emergency care to patients, especially surgical ones, is extremely high. During the epidemic, the treatment of burn patients who have not confirmed the absence or presence of a coronavirus infection, the processes of establishing intravenous access, endotracheal intubation or tracheostomy, wound treatment and surgical intervention are the points of risk of infection. The introduction of an effective, appropriate degree of protection and the development of practical medical procedures will increase the level of protection of the medical worker and reduce the risk of infection with COVID-19. The aim of the work is to investigate the features of providing antiviral protection for medical workers and to study the existing practical treatment protocols for providing emergency medical care to patients with thermal and chemical injuries during the spread of COVID-19.

Nipah virus is an emerging paramyxovirus in the family Paramyxoviridae that infects humans as well as animals. It was first discovered in Malaysia in 1998 and has since spread across Southeast Asia. There are two strains of Nipah virus: the Malaysian strain (NiV-M) and the Bangladeshi strain (NiV-B) (NiV-B). NiV’s natural hosts are fruit bats of the genus Pteropus (“Flying bat”), which are the main risk factor for Nipah virus disease. Bats of the genus Pteropus are distributed across Asia's tropics and subtropics. Domesticated animals contract NiV after eating contaminated fruit, drinking polluted water or eating aborted bat fetuses or birth products. NiV is transmitted between bats and people through two main routes: intermediate hosts and food-borne transmission via date palm sap contaminated with fruit bat saliva or urine. The condition is extremely deadly, causing severe neurological and respiratory symptoms. A number of immunological and molecular diagnostic techniques have been developed for diagnosis and surveillance of disease. Diagnosis and management become more challenging when a new area is affected. The high mortality rate associated with infection, as well as the risk of infection spreading to other areas, has highlighted the significance of proper care and control of this life threatening zoonosis. For the time being, there is no treatment or vaccine available for Nipah virus infection. Preventing infection in livestock could be a valuable management method in places where they act as intermediate hosts. Humans can avoid contracting Nipah virus disease by avoiding direct contact with infected hosts (fruit bats and pigs) or their secretions.

Purpose Since the first Italian case of SARS-CoV-2 was detected in Lombardy (Northern Italy) Italy quickly became one of the worst-affected European countries, with a severe impact on health-care workers (HCWs). In the first epidemic, HCWs accounted for 12% of all national COVID-19 cases. We evaluated the burden of COVID-19 among HCWs and other non-health-care workers (nHCWs) in a large Italian hospital. Methods From March 1st to May 31st 2020, we performed a retrospective study at ASST Civil Hospital, in the Province of Brescia, Lombardy. The study population included all hospital personnel (n = 9265), categorized by professional status. Results A SARS-CoV-2 test was performed in 3572 workers (38.5%), with a positive result in 552 (5.9% of all hospital personnel). The temporal trend of SARS-CoV-2 cases in hospital staff broadly reflected that in the community, with a great majority of infections occurred during March 2020 (87.7%). From April onward, a steep decrease of positive cases was observed among hospital personnel, while in the community the decrease was much slower. Medical doctors (8.9%) and nurses (8.5%) were the most affected professional categories with a significantly higher risk of SARS-CoV-2 infection (OR 1.436 and OR 1.410, respectively p p Conclusion HCWs were severely affected by the COVID-19 epidemic, probably associated with an overwhelming burden of work and lack of preparedness in prevention of nosocomial transmission of the infection. The rapid decrease of COVID-19 spread in the hospital, registered before the one in the community, suggests that the adopted preventive measures were effective.

To explore the relationship between low-density lipoprotein cholesterol (LDL-C) level and infection risk in elderly stage 5 kidney disease (CKD) patients. This study retrospectively analyzed all 378 patients with grade 5 CKD over 60 years old treated in the Nephrology Department of our hospital from February 2014 to July 2019, including 286 cases with infection and 92 cases without. According to LDL-C levels, the patients were divided into three groups (Tertile 1-Tertile 3). Basic patient data and laboratory test results were collected for all three groups for analysis. The incidence of infection showed a gradually decreasing trend in the three groups (from 80.2, 78.6 to 68.3%), along with increasing LDL-C levels from Tertile 1 to Tertile 3, although the differences were not statistically significant (p = 0.075). After fully adjusting for confounding factors, the risk of infection was significantly reduced (OR = 0.646, 95% CI 0.420–0.993, p = 0.046) with increasing LDL-C levels. For the LDL-C levels of the three groups, the rising trend of LDL-C was significantly associated with the reduction in infection risk (OR = 0.545, 95% CI 0.317–0.937, p = 0.028). Curve fitting revealed that LDL-C levels were linearly negatively associated with the risk of infection, and the relationship between the two was not affected by the other factors (p for interaction: 0.567–1.000). LDL-C level is linearly negatively associated with the risk of infection in elderly patients with stage 5 CKD.